They write about the Cleveland Clinic, showing the various ways in which it has cut costs while improving patient outcomes and how it hopes to be a model for ways in which the delivery of healthcare could be reformed.

But there is one major problem they can do nothing about.Â They describe the clinic’s clerks.Â Picking up the phone to deal with the “thousands of different health plans from the hundreds of companies all over the country” and getting “put on hold like anyone else who calls an insurance company.”Â Industry estimates, they say, are that the average cost of handling a phone call is $3 to each party. “This is the hidden cost of competition…”

So, one might wonder, reading that, how many phone calls are there per case?

What dropped my jaw was what they said next: there are 2,000 doctors at Cleveland. They have to keep 1,400 clerks to deal with those companies. And they know, their CEO says, that the insurers have just as many people working on each of those cases, doing everything they can to examine them.Â And then if they can in any way they will deny or at least delay each claim for as long as possible.

Which is one big reason why the overhead for private insurers averages out, Cleveland Clinic’s CEO says, at 29% vs. Medicare’s 3%.Â (As an aside, I have read that the Blue Crosses of California run at about 50%.)Â That’s just on the insurers’ end in terms of the lost money that could have been spent on actual care of human beings in actual medical need.

Cleveland, it should be noted, told insurers what its average maternity cost was and offered to simply charge that average fee per baby delivered to each, freeing themselves and all those insurance plans all the costs of all that wrangling and nitpicking.Â Spend that premium money on the patients instead! Please!

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Borrowing another photo from last year to brighten things up a bit while impatiently waiting for my amaryllises to start budding for the season.

Someone spoke at church today about her family’s reunion held in Thailand a few years back; they’d originally booked four days on the beach, but after they’d been there a day or two, decided, you know, we’d really like to go to church; where’s the nearest?…

And so they’d left that hotel in Phuket. After they got safely further north, they felt a bump that was the earthquake that triggered the tsunami.

The hotel they’d just been in was gone.

I told the speaker afterwards of my encounter with my neighbor who had just spent a month driving relief trucks for the Red Cross after what was, for her, too, supposed to be a family vacation in an exotic spot.Â How my neighbor, in the aftermath, was going from being intensely needed and involved and actively participating in the helping and in the grieving, to being home, where–nobody knew.

And somehow just in that moment as she stepped out of that car from the airport, I went outside to check my mailbox and saw her and went over to welcome her, having no idea where she’d been on her trip or why she’d been gone so long.Â She threw her arms around me and sobbed the whole story.

It was easier to bear now: someone here knew.

And now that woman at church knows my neighbor knows what it was like to be there in Thailand on that day, someone in this city knew that beach too, someone right here loved those people and wonders and cares about them still.

Someone else knows.

And that is an inherently comforting thing.

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Okay, that last one was an in-joke among hearing aid users.Â Those orange tabs are what you pull off the air-activated batteries before putting them in the aids. They made for longer fingernails than I’ll ever have; all my growing up, my piano teacher told me that if I showed up at her house with nails long enough to click on the keyboard, she would cut them or I would. Period.

To this day, long lovely fingernails are a spectator sport.

Meantime, (this is a picture from last summer, sorry I don’t have a newer one, Kris is wearing her Water Turtles shawl) yesterday I got to see Mel and Kris at a show in San Jose–I only went because they were there. You know, pottering around a little bit here and there but mostly spending my time catching up with them; I went in the afternoon when the crowds had died down quite a bit so we could visit and not have me be in the way.

And there’s a great story to it all.Â But I can’t tell it yet. I know, I’m so mean…

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Crazy-busy trying to do everything that needs to be done before our own guests might or might not arrive, but first, for Carol, who would really appreciate this, I present: Fingernails on Friday!Â Heh.

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The spiced pecans (hey, wait, I made more than that you guys!) and two batches of cranberry sauce filled the house with Thanksgivingness and good smells yesterday after I posted, telling us, don’t quit your dye job.

The chocolate torte’s about to be taken out of the freezer.

The silk is staying blue.

Yes, Carol, the stole is finally finished. (Quick, grab some new yarn! I can’t go without a project!)

Over the river and through the redwoods, to auntie’s house we go.Â Have a blessed, wonderful Thanksgiving day, everyone.

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She came running down the hall in mock outrage.Â “MOM! What are you DOING!”

(Is this a trick question) “Dyeing some yarn…?” I answered innocently.

“This is NOT a Random Act Of Cleanliness! It STINKS!”

Oh.Â But I was desperate. I hadn’t done any dyeing for a whole solid year!Â I had wanted so badly to play with my watercolors, and I had some undyed yarn I’d bought to play with, and it only took a few moments to set up…

“This is NOT what you do the day before Thanksgiving! The house is supposed to smell like food, not cooking silk! It *stinks!*”

I can’t lift my heavy dyepot yet, and I’d finally looked up microwave dyeing to see how long the stuff should cook in there.Â Just a few minutes’ worth of boiling time? Hey.Â I had a dedicated glass bowl, I’d covered it with plastic wrap and poked a hole in the center for venting to keep the thing from exploding dye, and to be certain of colorfastness, I did let it go for ten minutes–a third less time than on the stove.

It did not spill in any way.Â It’s gorgeous.Â It’s mine. I finally get to sing my own blues. TaDAAH!

I have been sentenced to spicing the pecans in penance.Â The silk/wool has been sentenced to cooling outside.Â “And if the squirrels dye themselves blue, Mom, they so deserve it!”

I don’t think I’ll mention yet that I’m considering throwing a little green in there in overdye mode.Â Just for fun.

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I got an email the other day: the cardiologist had been wanting to keep tabs on me, post-op and all that, would I come in?

Well, okay, not that I needed to.

It was a tad chilly in his office, so I was just as glad this afternoon that that stole I was working on was long enough now to heap up in my lap and go all the way down to my foot as I worked on it.Â I’d rinsed it the other night, still on the needles, to see how the pattern was coming out in real life: it was the first time I’d ever seen the stitches settled into shape in that new pattern, and I was really, really pleased.Â That also gave me a much better idea ofÂ what the length was by now.Â (Nope–keep going.)

All the better to show the thing off as I work.

I knitted. It’s a given that there are other patients in a bigger hurry in that specialty than I, thank goodness, am in.Â I imagined fewer cardiac episodes among calm patients making beautiful things out of soft cashmere and alpaca for their loved ones–how about we set up a knitting class in that waiting room. Yarn samples to fondle, let’s start with that.

And I knitted.

The doctor exclaimed over it as he came in and said, with a grin, “Did you start that after you got here?”

Hey, I didn’t wait THAT long!

I almost added, Go take care of someone else for another hour or so so I can finally get this finished, willya?

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I like to bake, but frankly, Trader Joe’s makes a better pecan pie than I do.Â A quick trip to the store…

I like to grin and tell my friends that I’m going to be a terror to my kids when I’m 90.

My kids tell me I don’t have to wait that long.

But it was a complete innocent today who was horrified.Â Â Some large and tall hunter-gatherer, oblivious as he focused on his prey, collided with me on his way by. I don’t weigh much. He never noticed.

My sense of balance is visual and tactile only, and if you throw one of those off, you get to see me do my rendition of Olympic figure skating.

Kinda like the time I fell down the carpeted steps at my aunt-in-law’s house during her daughter’s wedding reception. There was a young couple coming up behind me, gasping in horror. I managed to stop finally about 2/3 of the way down while thinking, great, I hope nobody saw THAT little act of gracefulness, turned back, saw them, and got this big cheesy grin on my face as I threw my hands up from where I sat and proclaimed, TaaDAAAH!

They cracked up, mostly out of relief.Â Phew!

So this guy goes past me and it all went past him.Â But a woman standing on the other side thought somehow she’d done that to me, and was not reassured by my attempt to brush her fears off. It bothered her enough that she got behind us in the check-out line so that she could apologize again.

I’d had no idea, or I’d have been more particular in what I’d said–to me, going flying occasionally is simply how things are, and I do use that cane.Â I guess sometimes a person needs to be told more of the story.Â Not just, no, you didn’t do that, not even just no, that other guy bumped into me, but also that, really, the only person who needs to apologize is the guy who creamed my car nine years ago.

But it was the strength and warmth of the smile on my face towards her as I said that, not so much the words, that finally made her feel better about the whole thing.

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Don’t have a mattress pad yet for one of the new futons, need more blankets, no hurry, we’ve got till December 22 before the rooms have to be ready for the kids.

(Phone rings.)

I haven’t met my nephew Garrett’s new wife yet; they got married right around my second surgery, it involved a multi-hour drive from the airport, and the reception was held out in the sun. Strike three, I was out.

Michelle assures me the bride is a peach.

My little sister, on the phone an hour ago scouting ahead for the couple and her new daughter-in-law’s sisters, said that the young’uns’d like to come to San Francisco after spending Thanksgiving with the girls’ aunt in Reno, and what’s four more hours on the road, right? Would we like a visit?Â Could they come? For a few nights?

Heck YEAH!!!

Oh.Â (Shhhh…)Â Suddenly that yarn and project sorting/clearing/putting away/blanket shopping/carpet cleaning/scrubbing/you name it/ is on the fast-forward list. Could we repaint the house and redo the driveway while we’re at it?Â No?

The house, of course, is not what it’s all about.Â We’ll do our best, they’ll be patient with the rest.

…I wonder where I put the pictures from a dozen years ago of Garrett and his brothers and our kids splashing together at Stinson Beach.Â I had knitted an afghan that was a picture of a beach, for someone else, and when the film came back, I had accidentally double-exposed it.Â I could not possibly have superimposed the knitted tide on the real one if I’d tried, but by not trying, there’s John, foot held high in glee, about to stomp on the incoming knitted (and the real) water…

I can’t wait!

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I *knitted, I ripped, repeat from* to end of row, and the impatient part of me finally changed to a fingering weight baby alpaca that could take that kind of abuse more easily.Â (And it, too, is just SO soft–no complaints.)Â All in good time on that laceweight.

The thing that made the most sense was to make a very wide swatch and just keep going and keep checking.

I have had a particular lace idea dancing around my head for over a year now.Â But since I don’t do charts (it’s a brain injury thing), designing a new lace pattern means figuring out intuitively how many and how and where each stitch should go, and then sitting down and hashing it out till the thing proves itself. Â Or not.Â (I’ve got some real nots in my yarns in that closet.)Â I’d been avoiding the whole hassle for a very long time, a bit frustrated at myself for not having already done it.

But it was exactly the thing, exactly the most perfect thing, for that guy at Safeway and his girlfriend, if I could just make it work.Â If nothing else, this gave me the impetus to wrestle the thing into existence.

…And once I got going, really, it wasn’t hard.Â I was so excited at my success last night, after it had been delayed so long by my own reticence, that I could hardly sleep.

It is past the idea stage. It is past the notes on paper stage. It is past the fixing the typos stage.

Twenty-five inches and 1.5 oz of melt-in-your-hands done, 3 oz left to go.

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Dropped the camera the other day, which is why UCSF had to settle for the cell phone.Â It seems to be staying dropped.

Anyway.Â I ordered some merino/silk/cashmere laceweight yarn recently, two skeins of Plymouth’s new Dye For Me line, looking forward to seeing how the different fibers would create a heathery effect in taking up colors–silk being slowest so it always comes out lightest. I was curious to see if they were so thoroughly carded together you wouldn’t be able to tell, or…?

And yet, when they came, I wanted to ball at least one up immediately.Â It was so soft.

No.Â Then it’ll be a given it will stay white. I bought this specifically for dyeing.

It nagged me. It begged. It pleaded. Repeatedly.Â But it stayed in that hank with its label firmly gripping its racetracked little shape.

Till today, when I realized that the reason I couldn’t find any more Fino was that I’d already knitted it all, and that newbie was doing a singsongy little “Neener neener NEENER, I *toldja* so!”

A little more swatching and that flower lace pattern should be ready for knitting up into the shawl I’m thinking of.Â In white.Â In softness.Â In my hands, and then someone else’s.Â Because, after all, you never know who you might run into.Â (If it’s meant to be, it will happen.Â Knit like crazy, and then, like I told the guy in that line, I’m in no hurry.Â I can wait.)

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It was a wonderfully ordinary afternoon, and I thought, as I ran to the post office, then the pharmacy, how different it was to be able to run do such things than, say, how things were ten months ago.Â I loved every minute of the freedom of it.

And I needed to pick up some milk and some soy milk on the way home for our hot cocoas.Â Not a problem, the grocery store was a straight shot down that road and then leftÂ and then home.

Nah, I think I’ll go to the one on Middlefield.

But the other one won’t involve any backtracking…

I went to Middlefield.

It was late afternoon by then and the Safeway was crowded, as groceries always are near dinner time. I was at the end of my checkout line when I saw a man standing behind me, scanning the rows, trying to figure out which would get him out the door the fastest.Â Tall, a young face but hair gone already gray that reminded me that mine had gone prematurely so too–but I really can’t call mine that now at 50.

He had a bouquet of flowers in his hand.

I offered him to take the spot in front of me and smiled, “I’m not in any hurry. Go ahead.” He hesitated, then accepted.

After a moment, I admired his flowers. He looked away, then back, andÂ answered, “They’re for my girlfriend.” Then, hesitatingly,”I hope she forgives me…”

He told me he had heard someone pounding on his apartment door the night before and had had no idea who nor why and had had no intention of opening it to some…(he shook his head) out there.

Turned out it was her. Her car had been broken into, her computer was gone, she was very upset, and…

…and he hadn’t known and he hadn’t opened that door. He felt absolutely terrible.Â He was hoping she would accept his gesture of peacemaking.

This time I was assuring him when I affirmed that those flowers were beautiful.Â To make him feel better, I told him my brother had once stood his girlfriend up for a date–because his apartment complex was on fire.Â His girlfriend, waiting and waiting, had finally driven over to his place to see what was up, feeling like something must be wrong–and when she didn’t see him in the crowd, she’d ducked past the firemen’s tape and had run in to try to save him.

(He was on the phone in the manager’s office by then, out of her sight, trying to call her to explain that he’d been trying to save his guitars when he’d suddenly realized, oh no!…Â But I didn’t go into that level of detail in the telling.)

I continued, “Our mom said to Bryan, You have to propose to her. Nobody else can live up to that story.”

Huh.

It immediately hit me that I didn’t know why I’d phrased it that way.Â What Mom had said, was, “You have to marry her. Nobody else can live up to that story.”

But it strongly felt like, the way I’d said it was the way this man needed to hear it, and it had just popped out the way God had intended in spite of how I of myself would have phrased it.Â It felt like, stand back, Alison, I’ll take over here.

Wow.Â And huh.

He asked, “And did he?”

There was much joy in my face as I smiled and nodded yes, thinking how much I adore my sister-in-law.

We talked a little about his girlfriend’s dog; how to win it over.Â He remarked on its having white fur now around its muzzle, and I grinned, “Don’t we all.”Â That stopped him a moment, as if he hadn’t noticed my gray hair before just then, nor, almost it seemed like, his own.

He was lost in thought and I left him to himself as his things were checked out, while the clerk, who’d been quietly listening in on the whole thing, smiled a deep smile, first at the man, then at me.

And then the clerk was suddenly calling after the man’s back–he’d completely forgotten to take his groceries with him. The salmon steak for two.Â Those flowers.

It wasn’t till I was driving home that it hit me that I could just picture that man in that line telling his girlfriend that evening that nobody else should have to live down a story like that.Â I could just picture him proposing over a salmon dinner and flowers.

I of course don’t know if he did: I do know that somehow, before that thought had even jelled, I came out of there feeling absolutely elated on his and her behalf for their future, so much so that I wanted to dance.

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For two years now, I wanted a picture of looking UP at the trees from the 12th floor at UCSF’s Moffitt Hospital; this is via my phone after my camera conked out.

I love San Francisco. And as someone with terrible balance, I’m glad this time we didn’t park outside in the lot where the earth is many stories’ worth straight down from the nose of the car.

I’m in a longterm study of lupus patient outcomes, and it’s been two years (note on that link: I got sent the most beautiful picture of that newborn baby and his mom later.)Â Time for me to come back for the in-person part of the study. Actually, they wanted me in July… When I told them what my surgery was going to be, Sandi, my interviewer this time, pushed the appointment way back to November over my protests that surely I’d be up to coming in sooner than that!

Wise woman.

Michelle drove.Â A wise woman, too.

And by the way, Haight-Ashbury just down the hill still looks exactly like you’d expect it to, psychedelically colorful storefronts and all. Peace, man.

So I have now been pushed, prodded, bled, challenged, tested, and assured that there are no points taken off for the artwork in not drawing my lines straight in their tests.Â (“Oh, I LOVED doing this in first grade!”) I now know I can spot and connect ABC’s in order faster than 123’s. Is anyone surprised?

Get strapped into a machine and swing your leg in resistance as hard as you can: set the timer, GO!

Take the words blue, green, and red, printed in varying colors, and say the colors the words are printed in, not the words themselves, line after line: set the timer, GO!

Repeat as many of this string of unrelated words as you can think of: set the timer, GO! (Note to self–if you repeat each word after she does as she presents the list, you remember fewer, not more of them: there is much to be said, in this and in all things, for simply quietly listening.)

Note that I had a mental image of a termite with its shorts hanging low, pliers stuck in one pocket, chomping on a tangerine, a nice warm summer watermelon on the picnic table in front of it and its drill at the ready to slice the thing up, trying to remember that list that just blew off in the breeze.

Then I had to explain why I was cracking up.

Actually, we did a lot of cracking up.Â Sandi is a delight.

Overall bone mass, good, but 10% loss in that hip since two years ago. Yowsers! Bring on the extra hot cocoa in milk, it’s a bit chilly near the Golden Gate.

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I’ve been stumped all day. Too many ideas, none of them holding still for singling out.

So I wound up a thousand yards of silk. Then another 650 of violet Sea Silk. A skein of dark amethyst Fleece Artist here, a little blue sock yarn over there.Â Then I scoured the mill oils out of four hanks of undyed yarn that I’d like to add my own colors to and hung them to dry to be ready for… Pink? Greens and blues?

I felt like I got nothing done, I got a lot done, it just wasn’t actual knitting yet. (And it wasn’t till that Handmaiden Sugar Plum silk was wound and the long lines of deep rose and gold all fused in with the bits of blues and greens that I realized it: I’d bought a small-scale version of Rooster Rock! And of Mardi Gras! Huh.Â I guess I wasn’t done with it yet.Â Colors are like people: they’re influenced by the ones around them.)

But sometimes the preparations for the work feel like as much work as the work, and yet they are absolutely as necessary.Â Even when it feels like they’re only getting in the way. They’re not.

Okay, but I still need a good carry-around project for tomorrow’s big day in San Francisco.Â Deadlines–they’re helpful too, definitely. Hopefully… (running away from the computer…)

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A little more so-put-on-a-sweater-if-you’re-cold-in-here weather, a little more housework, a little more room readying.Â (Don’t mind that Rooster Rock blocking the way on Sam’s floor.)

Looking forward to being able to pick up the kids at the airport next month with a little silliness for my 1111th post: picture from Icanhascheezburger.com but, as the one small person in a tall-person family, the scroll-over caption is totally mine.